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I <br /> 0 <br /> By- <br /> Town of.1Vlashpee <br /> 1170 16 Great Neck.Road North <br /> Hashpee,MA 02649 <br /> PETITION FOR A MODIFICATION <br /> Date.. .. .......... �.w. :. _ ._ _....,. Zoning District �- <br /> Print <br /> Property Address <br /> t �° Phone (�Petitioner........ .._._" ...._�.. ........... ....... _.................. ....... ...�..?...... <br /> ` . <br /> Owner's Name ............. �, �.� . ;. � � ,��........... �.._ ._.Phone..,.,..,.��. ... <br /> Emaill. _ taJLc . . .I .bti ." ......... ......__. <br /> ZBA Original Docket Number //................a_.��_ 11 <br /> Project is a: ❑Deck UAddition ❑House C Other 1��, � C rrt' ► �. � . <br /> i� 17 <br /> Proposed Modification..........._ . .. .._.. ..... <br /> Current Lot Coverage ( % oposed Lot Coverage <br /> Owner's Signature or Letter °s <br /> ... ... .............. _-------- _.... .._. <br /> Petitioner's Signature <' w <br /> Mail certified copy of Decision to ....,....... m ��-�� ►�re�j: F .._ .tat� U� <br /> - - - - - - - - - - - - - - - - - - - - - <br /> Scheduled Date TOWN CLERK <br /> DATE STAMP <br />